Conferences

TCTAP

SEOUL VALVES

COMPLEX PCI

ACT Program

Search the news

Total: 208

SEOUL VALVES 2025

Out-of-the-Box Solutions for Mitral Valve Repair and Replacement N

At the 14th SEOUL VALVES 2025 meeting, during the Keynote Session: Cutting-Edge Innovations in Valve Therapies II, Dr. Eberhard Grube (University Hospital Bonn, Germany) presented an overview of emerging innovations in the treatment of mitral valve disease, under the theme “Out-of-the-Box Solutions for Mitral Valve Repair and Replacement.” He emphasized the need for new strategies beyond conventional surgery and transcatheter edge-to-edge repair (TEER), and highlighted novel technologies currently under investigation. Eberhard Grube University Hospital Bonn, Germany Dr. Grube began by revisiting the long-standing challenges of mitral regurgitation (MR) management, stressing the importance of early intervention to reduce regurgitation, promote reverse remodeling, and keep future treatment options open. Recent evidence, including 5-year outcomes from the COAPT trial, showed durable benefits of TEER in secondary MR. However, he underscored its limitations: achieving MR reduction alone may not be sufficient, and outcomes remain suboptimal in certain patient subsets. This has prompted exploration of novel concepts offering solutions for anatomies unsuitable for conventional TEER or surgery. He reviewed several investigational devices: the Half Moon system, designed to provide coaptation augmentation with a contoured baffle; the SUTRA, 3 Leaflet Hemi-Valve for posterior leaflet restoration; the Polares MRace device, offering active posterior leaflet replacement with encouraging early clinical results; and the CARLEN device (Transcatheter Cardiac Leaflet Enhancer), which enables wide and deep coaptation in functional MR across varied anatomies. First-in-human experiences demonstrated procedural feasibility and early reductions in MR, although long-term outcomes are still under evaluation. In closing, Dr. Grube emphasized that mitral valve disease remains “messy and complicated,” and that innovation requires the courage to move beyond established approaches. He concluded that while TEER remains the gold standard today, out-of-the-box solutions such as leaflet augmentation or hemi-valve replacement could expand the range of therapeutic options for challenging MR anatomies in the near future. Keynote Session: Cutting-Edge Innovations in Valve Therapies II Friday, August 8, 1:00 PM-2:00 PM Main Arena, B2 Watch Session Video

September 05, 2025 282

SEOUL VALVES 2025

Optimizing Medical Therapy After TAVR: Focus on SGLT2 Inhibitors N

At the 14th SEOUL VALVES 2025 meeting, during the Keynote Session: Cutting-Edge Innovations in Valve Therapies I, Dr. Duk-Woo Park (Asan Medical Center, Korea) delivered a keynote lecture titled “What Is the Best Medical Therapy for TAVR Patients?” He reviewed evidence for sodium–glucose cotransporter 2 inhibitors (SGLT2i) after transcatheter aortic valve replacement (TAVR) and introduced the design of an ongoing randomized trial in post-TAVR patients. Duk-Woo Park Asan Medical Center, Korea TAVR effectively relieves valvular obstruction but often leaves behind myocardial damage—fibrosis, hypertrophy—a high residual risk of heart failure (HF), especially in elderly patients underrepresented in earlier SGLT2i trials. This creates a strong rationale for optimal medical therapy (OMT) strategies that target remodeling and HF prevention in the post-TAVR period. In the DAPA-TAVI trial published in NEJM in 2025, patients were randomized 1:1 at discharge or within 14 days post-TAVR to dapagliflozin or usual care, stratified by diabetes, left ventricular ejection fraction (LVEF) ≤40%, and eGFR 25–75 mL/min/1.73㎡. Among 1,257 participants, the primary—composite of all-cause death or worsening HF—occurred in 15.0% with dapagliflozin vs. 20.1% with standard care (p=0.018; hazard ratio [HR] 0.72; 95% confidence interval [CI], 0.55–0.95), driven mainly by reductions HF hospitalizations or urgent HF visits. Effects were consistent across prespecified subgroups. Safety was acceptable overall, with higher rates of genitourinary infections and hypotension noted. Importantly, nearly one-third of post-TAVR patients experience HF readmission within 12 months, and many have preserved LVEF, a population not tested in prior TAVR-specific SGLT2i trials despite supportive data from EMPEROR-Preserved and DELIVER in general HF with preserved ejection fraction (HFpEF) populations. To address this gap, the ENAVO-TAVR trial (ENAVOgliflozin Outcome Trial in Patients with Severe Aortic Stenosis after Transcatheter Aortic Valve Replacement) has been initiated. The study will randomize 1,040 post-TAVR patients with LVEF ≥40%, structural heart disease (Left ventricular hypertrophy and/or left atrial enlargement), and elevated NT-proBNP to enavogliflozin 0.3 mg once daily (a dose equivalent to dapagliflozin/empagliflozin 10 mg) versus matching placebo within 2 weeks of successful TAVR. The primary endpoint is major adverse cardiovascular events (all-cause death, nonfatal MI, or stroke) or HF hospitalization at 1 year. Approximately 40 Korean centers are participating, and enrollment has begun. In conclusion, SGLT2 inhibitors show strong promise in improving post-TAVR outcomes by mitigating HF progression and promoting cardiac recovery. While DAPA-TAVI supports their use in HF with reduced LVEF and in patients with chronic kidney disease or diabetes, the ENAVO-TAVR trial will determine efficacy in the broader HFpEF TAVR population. Accumulating evidence supports integrating SGLT2i into OMT for TAVR patients to improve long-term clinical and structural outcomes. Keynote Session: Cutting-Edge Innovations in Valve Therapies I Thursday, August 7, 1:00 PM-2:00 PM Main Arena, B2 Watch Session Video

September 05, 2025 280

SEOUL VALVES 2025

16 Years' Journey in TAVR at Asan Medical Center N

At the 14th SEOUL VALVES 2025 meeting, Dr. Seung-Jung Park (Asan Medical Center, Korea) presented the 16-year journey of transcatheter aortic valve replacement (TAVR) at AMC, reflecting on its evolution from the pioneering era to its current status as a standard therapy in patients with severe aortic stenosis. Since performing the first case in March 2010 under the proctorship of Dr. Alain Cribier, AMC has now performed a total of 2,289 TAVR procedures, with more than 300 procedures performed annually. Over this period, AMC established itself as a leading center in Asia, reporting outstanding outcomes with a procedural success rate of 99.7%. Seung-Jung Park Asan Medical Center, Korea Evolution of TAVR Guidelines and Clinical Practice The 2020 ACC/AHA guidelines recommended TAVR as Class I for patients aged 65–80 years, while the 2021 ESC/EACTS guidelines adopted a higher threshold, recommending TAVR as Class I in patients above 75 years. However, real-world practice has shifted rapidly. Registry data from the United States demonstrated that by 2021, 78% of patients under 65 years already received TAVR, highlighting a strong trend toward younger and lower-risk patients. AMC's TAVR Success: The Role of Minimalist Approaches and CT Algorithms AMC’s success has been attributed to three key strategies: Heart Team collaboration, minimalist approach, and CT-based device selection algorithm. More than 99% of AMC cases were performed using local or conscious sedation without general anesthesia or transesophageal echocardiography (TEE) guidance. The average procedure time was only 30 minutes, with most patients discharged within three days. Pre-procedural CT analysis was emphasized as the cornerstone for device selection, incorporating vascular access, aortic annulus size, coronary height, and calcium burden. This meticulous planning minimized complications such as paravalvular leak (PVL) and the need for permanent pacemaker implantation (PPI). AMC favored balloon-expandable valves (88%), reporting lower PVL rates (2.5%) and acceptable permanent pacemaker rates (8.7%). Clinical outcomes were excellent: Thirty-day mortality was only 1.4%, with disabling stroke at 0.5%. At one year, all-cause mortality was 7.2%, reflecting durable benefit comparable or superior to outcomes from major international trials. Bicuspid Aortic Valve: Challenges and Outcomes A particular focus was given to bicuspid aortic valve (BAV) stenosis, which accounted for 217 cases (9.4%) in the AMC registry. Meta-analysis data including 12,462 patients indicated that bicuspid TAVR carried a slightly higher risk of moderate PVL and aortic root injury compared to tricuspid cases. In AMC’s experience, patients with bicuspid valves tended to be younger and had significantly higher calcium burdens (mean calcium volume 670 mm³ vs. 380 mm³ in tricuspid). Type I bicuspid anatomy was most frequent. Despite these challenges, outcomes remained favorable: propensity-matched analysis revealed no significant differences in hard endpoints such as cardiac mortality and stroke between bicuspid and tricuspid TAVR. AMC favored the use of Sapien 3 valves even in bicuspid cases, often performing pre- and post-dilatation in patients with heavy calcification. These findings reinforced that with meticulous CT planning and careful device selection, bicuspid TAVR can achieve outcomes comparable to tricuspid cases. Dr. Park concluded that TAVR had firmly established itself as the primary treatment for symptomatic severe aortic stenosis at AMC, with surgery reserved for patients unsuitable for TAVR. He emphasized that comprehensive CT analysis and tailored device selection remained the most critical factors for ensuring excellent outcomes, especially in complex anatomies such as bicuspid valves or small annuli. Opening, Live Case & Lecture 1: TAVR Thursday, August 7, 10:00 AM-12:00 PM Main Arena, B2 Watch Session Video

August 29, 2025 344

SEOUL VALVES 2025

Bicuspid TAVR: Technical Challenges and Asan Data Insights N

At the 14th SEOUL VALVES 2025 meeting, Dr. Jung-Min Ahn (Asan Medical Center, Korea) delivered a comprehensive lecture titled “Bicuspid TAVR: All the Technical Issues and Data from Asan Medical Center.” His lecture summarized the unique anatomical and clinical challenges of bicuspid aortic valve (BAV) patients undergoing TAVR, findings from the Asan TAVR Registry and an ongoing meta-analytic review. Jung-Min Ahn Asan Medical Center, Korea Bicuspid aortic valve disease is typically found in younger, male-predominant populations with fewer comorbidities compared with tricuspid valve disease. Echocardiographic and CT findings show that BAV is associated with more severe aortic stenosis, larger and asymmetric annuli, and markedly higher calcification volumes. In the Asan registry, mean calcification volume in tricuspid valves is about 300 mm³, whereas in bicuspid valves it nearly doubles to around 600 mm³ (Figure 1). In surgical series, up to 65% of patients under 60 years presented with BAV, highlighting the need to consider long-term valve durability and lifetime management strategies in this younger population. Figure 1. The heavier and asymmetric calcification burden in BAV makes device sizing particularly challenging. In cases with severe calcification (>1000 mm³), nominal sizing or undersizing is used to avoid annular rupture. With lower calcification burden, oversizing may be applied, even in type 0 BAV anatomy (Figure 2). Figure 2. Procedurally, larger transcatheter valves and more frequent pre- and post-dilation are often required, increasing the potential for annular rupture, coronary obstruction, or conduction disturbances. Nevertheless, Asan data suggest that overall complication rates remain acceptable and are not significantly higher than in tricuspid cases (Figure 3). Figure 3 . Two-year echocardiographic follow-up in the Asan registry showed that BAV patients achieved comparable outcomes to tricuspid patients; 1) Effective orifice area remained favorable, 2) Prosthesis–patient mismatch (PPM) was lower in BAV patients, owing to larger annular size, and 3) Mortality and stroke rates were similar between the groups at two years (Figure 4 and 5). Still, Prof. Ahn emphasized that long-term outcomes beyond five years remain uncertain. In the NOTION-2 trial, bicuspid patients younger than 75 years undergoing TAVR demonstrated numerically higher death and stroke rates, raising concern about durability and safety in this subgroup. Figure 4. Figure 5. In the meta-analytic review discussed during the lecture, which pooled results from 35 studies including over 13,000 BAV and nearly 200,000 TAV patients, BAV TAVR was associated with higher risks of adverse outcomes compared with tricuspid TAVR. Specifically, bicuspid patients experienced more frequent paravalvular leakage, aortic root injury, and higher rates of early mortality and stroke (Figure 6). By contrast, the incidence of permanent pacemaker implantation and major bleeding did not differ significantly between the two groups. Figure 6. When comparing TAVR and SAVR in BAV patients, published data suggest broadly similar short-term mortality and stroke rates. However, TAVR is associated with a greater risk of paravalvular leak, whereas SAVR carries a higher risk of bleeding complications (Figure 7). Figure 7. Dr. Ahn concluded that TAVR is feasible and safe in carefully selected bicuspid patients with current-generation devices, but several key principles must guide practice: Meticulous patient selection and pre-procedural CT planning are essential. Sizing algorithms incorporating calcification volume help mitigate complications. Strategies to reduce pacemaker implantation are particularly important in younger patients. Not all bicuspid anatomies are suitable for TAVR—there is a clear need for a BAV-specific scoring system to guide decision-making between TAVR and SAVR. Dr. Ahn’s lecture underscored that bicuspid anatomy remains one of the most challenging frontiers in TAVR. With ongoing data collection and refinement of devices and implantation techniques, patient-tailored strategies will be critical to optimizing outcomes for this complex group. Live Case & Lecture 2: Complex TAVR (Bicuspid) Thursday, August 7, 2:00 PM-3:30 PM Main Arena, B2 Watch Session Video

August 29, 2025 327

SEOUL VALVES 2025

TAVR Expectations for the Next Two Decades N

At the 14th SEOUL VALVES 2025 meeting, held on August 7–8, Dr. Alan C. Yeung (Stanford University School of Medicine, USA) presented “TAVR: Expectations for the Next Two Decades” during the Opening, Live Case & Lecture 1: TAVR session on August 7, delivering a detailed perspective on how transcatheter aortic valve replacement (TAVR) may progress over the next two decades. Alan C. Yeung Stanford University School of Medicine, USA He began by tracing the evolution of interventional cardiology, comparing the maturation of drug-eluting stents (DES) — which achieved stability within about 18 years — to the still-developing trajectory of TAVR. Since the first procedure in 2002, TAVR indications have expanded from inoperable to low-risk patients, yet several challenges remain unresolved, including anatomical complexity, device limitations, and strategies for long-term durability and repeat interventions. Looking forward, Dr. Yeung outlined potential innovations: valves engineered for 30–40 years of durability, smaller delivery profiles, 3D-printed patient-specific designs, AI-driven preoperative planning and intra-procedural guidance, and wearable sensors for continuous monitoring of valve function. A significant portion of the lecture addressed bicuspid aortic valve disease (BAVD), emphasizing that suboptimal transcatheter heart valve (THV) expansion in this setting is linked to poorer clinical outcomes. To address this, recent advances such as mechanical leaflet splitting (ShortCut™) and intentional leaflet laceration (BASILICA) were discussed as strategies to improve valve expansion, optimize annular sizing, and reduce procedural risks in complex anatomies. He also reviewed the expanding role of TAVR in treating aortic regurgitation and in valve-in-valve (ViV) procedures. These indications present unique technical challenges, including anchoring in non-calcified annuli, limited fluoroscopic visualization, and the prevention of coronary obstruction. In this context, Dr. Yeung emphasized the importance of lifetime management of aortic valve disease, noting that the choice of the first THV can significantly impact future procedural options. The session concluded with an outlook toward achieving the “one valve for life” concept, supported by next-generation synthetic polymers and novel tissue-processing methods designed to overcome current durability limitations in bioprosthetic valves. Opening, Live Case & Lecture 1: TAVR Thursday, August 7, 10:00 AM-12:00 PM Main Arena, B2 Watch Session Video

August 22, 2025 396

SEOUL VALVES 2025

Minimally Invasive SAVR Gains Ground at Asan Medical Center, Combining Safety With Faster Recovery N

SEOUL, South Korea—At the 14th SEOUL VALVES 2025 meeting, Dr. Joon Bum Kim (Asan Medical Center, University of Ulsan College of Medicine, Korea), delivered an update on his center’s 25-year experience with surgical aortic valve replacement (SAVR), showing that minimally invasive approaches are steadily replacing conventional full sternotomy in routine practice. With adoption rates climbing from less than 20% before 2019 to 52% by 2025 for the right anterior thoracotomy (RAT) approach alone, Dr. Kim says the data—both global and institutional—provide a compelling case for change. Joon Bum Kim Asan Medical Center, Korea “We are moving toward a far more convenient and less invasive approach,” he told attendees, noting that incisions are now typically 5 cm or smaller, without rib cutting, and in some centers abroad can be reduced to just 3 cm with thoracoscopic or robotic assistance. Global Evidence: Less Trauma, Comparable Safety Dr. Kim began with a review of the international literature. A meta-analysis of 14 randomized controlled trials (RCTs) involving 1,395 patients compared full sternotomy with mini-sternotomy and found no statistical difference in early mortality. However, minimally invasive approaches offered significant advantages in shorter hospital stays, less blood loss, lower pain scores, and improved quality of life. He then pointed to a large observational study from 10 centers in Italy and Germany involving nearly 6,000 patients—propensity-matched to create roughly 2,200 balanced pairs—which included both mini-sternotomy and thoracotomy. In that analysis, minimally invasive approaches reduced 30-day mortality by 37% compared with full sternotomy (OR 0.63; 95% CI 0.43–0.93; p=0.021). Importantly, this survival benefit was consistent across hospitals and surgeons regardless of case volume. The Asan Experience: Strong Alignment With Global Trends From 2000 to April 2025, Asan Medical Center performed 2,437 isolated SAVR procedures, 937 of them in the past five years. Overall, unadjusted 30-day mortality was 0.36% for minimally invasive surgical aortic valve replacement (MICS SAVR) compared with 1.02% for conventional full sternotomy. A detailed propensity-score matched analysis compared three groups—full sternotomy, mini-sternotomy, and RAT—each with 281 patients. Procedural times were longer in the minimally invasive groups, but early outcomes were statistically similar: Early Mortality: 0.0% for full sternotomy, 0.4% for mini-sternotomy, and 0.7% for RAT (p=0.36) Bleeding Reoperation: No significant difference (p=0.20) Disabling Neurological Events: No significant difference (p>0.99) Interestingly, patients selected for minimally invasive approaches at Asan were on average older and had more comorbidities, including higher rates of diabetes, dyslipidemia, chronic lung disease, and end-stage liver disease—yet maintained comparable safety profiles. Quality-of-Life Benefits and Surgeon Experience Although quality-of-life and pain data for SAVR patients were not directly measured in this analysis, Dr. Kim referenced Asan’s separate study of more complex aortic arch surgery showing that mini-access approaches significantly lowered pain scores and shortened hospital stays. “I strongly believe these benefits apply to surgical AVR as well,” he said. Surgeon experience remains a key factor in success. At Asan, four large-volume surgeons perform 69% of all SAVR cases, with some exceeding 90% MICS use. This concentration of expertise has enabled a steady transition toward minimally invasive techniques. “Despite high surgeon-dependent variation in practice pattern, large-scale meta-analysis and multi-center data indicate that MICS SAVR probably enhances clinical outcomes,” Dr. Kim emphasized. A Technique Poised for Wider Adoption For Dr. Kim, the case is clear: minimally invasive SAVR offers a safe, effective, and patient-friendly alternative to conventional surgery—particularly in experienced hands. “Our data go well with recent findings, with promising results,” he concluded, adding that the approach’s advantages in recovery and comfort could help it become a new standard for suitable patients worldwide. Keynote Session: Cutting-Edge Innovations in Valve Therapies II Friday, August 8, 1:00 PM-2:00 PM Main Arena, B2 Watch Session Video

August 22, 2025 377

TCTAP 2025

IVUS or OCT in Bifurcation PCI: Is There a Gold Standard?

At TCTAP 2025, in the breakfast session of 'Imaging & Physiology I', Dr. Imad Sheiban (Pederzoli Hospital, Italy) addressed the evolving role of intravascular imaging in bifurcation PCI. He emphasized that angiography alone is often insufficient to guide complex bifurcation interventions. Instead, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have become essential tools to evaluate plaque composition, lesion morphology, and optimize procedural results. Imad Sheiban Pederzoli Hospital, Italy IVUS and OCT provide valuable insights such as vessel sizing, plaque burden, stent expansion, malapposition, edge dissection, and side branch jailing. Longitudinal vessel imaging can also help predict carinal shift and side branch compromise. Dr. Sheiban illustrated how OCT’s superior resolution detects subtle stent malapposition and edge dissections, whereas IVUS offers better vessel wall visualization in larger vessels. Recent randomized trials and meta-analyses, including the OCTOBER and OCTIVUS studies, have confirmed that both IVUS- and OCT-guided bifurcation PCI improve clinical outcomes compared to angiography guidance alone. Both modalities are safe and effective, with no clear superiority. In conclusion, Dr. Sheiban noted that the decision to use IVUS or OCT should be individualized based on clinical context, lesion complexity, and operator experience. “The use of intravascular imaging must be incorporated into daily practice for optimal bifurcation PCI outcomes,” he stated. Imaging & Physiology I Thursday, April 24, 7:00 AM-8:00 AM Presentation Room 1, Level 1 Check The Session

June 05, 2025 1394

TCTAP 2025

Bifurcation PCI Strategy After ISCHEMIA: Don’t Touch Small Side Branch!

At TCTAP 2025, during the "Bifurcation PCI: New Concept and Approaches" session, Dr. Seung-Jung Park (Asan Medical Center, Korea) delivered a lecture redefining the approach to bifurcation PCI in the wake of the ISCHEMIA study. Focusing on both non-left main (non-LM) and left main (LM) bifurcation lesions, he emphasized that these two entities demand fundamentally different strategies—simplification for the former, and individualized precision for the latter. His message for non-LM bifurcation was clear and bold: “Don’t touch small side branches.” Seung-Jung Park Asan Medical Center, Korea (Republic of) Citing results from the ISCHEMIA trial and subsequent meta-analyses, Dr. Park emphasized that percutaneous coronary intervention (PCI) confers no survival advantage over optimal medical therapy (OMT) in stable ischemic heart disease—even in patients with multivessel disease or severe ischemia. This shift in philosophy calls for a more judicious and physiology-driven approach to PCI, especially in bifurcation settings. In non-LM bifurcations, over 80% of side branches were found to supply less than 10% of the myocardial mass. These "small" branches—defined as those with a reference vessel diameter 2.5 mm)—especially in true bifurcation lesions (Medina 1,1,1 or 0,1,1)—he advocated upfront two-stent strategies. Still, Dr. Park underscored that unnecessary treatment of jailed side branches, even when angiographically narrowed, should be deferred unless functionally significant. For LM bifurcations, Dr. Park clarified that a separate strategy is warranted. Unlike non-LM lesions, LM disease often involves larger branches with substantial myocardium at risk. Here, intravascular imaging and FFR play pivotal roles in guiding one- versus two-stent strategies. When the left circumflex artery (LCX) is large and disease is truly bifurcated, upfront two-stenting is justified and can reduce the risk of side branch occlusion without compromising outcomes. Dr. Park concluded by summarizing his clinical rules: Don’t touch small side branches (

June 05, 2025 1216

TCTAP 2025

FFR-Guided PCI Matches CABG in Long-Term Outcomes

In the “Late-Breaking Clinical Trials 2025” session at TCTAP 2025, Dr. William F. Fearon (Stanford University, USA) presented the final 5-year results of the FAME 3 trial, showing that fractional flow reserve (FFR)-guided PCI delivers comparable long-term outcomes to coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease. William F. Fearon Stanford University, USA CABG has long been considered the gold standard for multivessel coronary artery disease, with previous studies consistently demonstrating its long-term superiority over PCI. But according to Fearon, most of that data is outdated. FAME 3 trial was designed to reflect contemporary clinical practice, incorporating advanced stent technologies, physiology-guided PCI, and optimal medical therapy. The FAME 3 trial enrolled 1,500 patients across 48 centers worldwide, randomizing them to receive either FFR-guided PCI with contemporary drug-eluting stents or angiography-guided CABG. Importantly, both groups received optimal medical therapy, with high rates of statin, antiplatelet, beta-blocker, and RAS inhibitor use. At five years, the composite endpoint of death, stroke, or MI occurred in 16% of PCI patients and 14% of CABG patients (HR 1.16, 95% CI 0.89–1.52; p=0.27) (Figure). Landmark analysis indicated that the early advantages of CABG did not extend beyond the first year. Mortality was identical in both arms at 7.2%. While the stroke rate was numerically lower with PCI (1.9% vs. 3%), MI (8.2% vs. 5.3%) and repeat revascularization (15.6% vs. 7.8%) occurred more frequently in the PCI group (Table). “Despite higher rates of MI and repeat revascularization, we found no difference in the hard endpoint of death, stroke, or MI at 5 years between FFR-guided PCI and CABG,” Dr. Fearon said. “This marks a notable shift from previous trials. There was no late accrual of benefit with CABG after the first year.” Subgroup analysis based on SYNTAX score revealed significant interaction: patients with low (

May 30, 2025 1225

TCTAP 2025

Left Main and Multi-Vessel Revascularization 2025: Updated Guidelines and Beyond

At TCTAP 2025, during the "Left Main & Multi-Vessel: Updated Practice and New Concept" session, Dr. Gregg W. Stone (Mount Sinai, USA) presented the 2025 updated guidelines on coronary revascularization, focusing on left main and multivessel disease. Reflecting recommendations from major U.S. cardiovascular societies, the new guidance emphasizes both clinical evidence and patient-centered decision-making. Gregg W. Stone Mount Sinai, USA For symptomatic patients, revascularization (PCI or CABG) is a Class I recommendation to relieve angina when medical therapy fails. PCI becomes a reasonable option (Class IIa) in patients unsuitable for surgery. In left main disease, CABG is recommended for high-complexity cases due to survival benefits. When PCI can achieve equivalent revascularization, it may be reasonable in low-to-moderate complexity settings. Contrary to expectations, diabetes did not significantly alter outcomes in left main disease, though complexity (measured by SYNTAX score) did show impact, with CABG favored in high-risk cases. For multivessel disease, pooled trial data reveal a modest mortality benefit for CABG over PCI—especially in diabetics, where the difference reaches 5.5%. Non-diabetic patients show no significant mortality difference. A consistent more stroke risk (~1%) with CABG remains a consideration. Dr. Stone referenced trials like SYNTAX, EXCEL, and FAME 3. While early benefits of CABG were noted, long-term outcomes—such as death, stroke, and MI—tended to converge. The FAME 3 trial showed PCI and CABG have similar long-term results in triple-vessel disease. In patients with left ventricular dysfunction, CABG showed a survival benefit in the STICH trial. However, this was not replicated in the smaller REVIVED-BCIS2 trial, highlighting variability in results depending on study size, duration, and patient characteristics. Dr. Stone closed by stressing the importance of shared decision-making. “For many patients, outcomes between PCI and CABG are very similar,” he noted. “Preferences, comorbidities, and anatomy should all guide the final treatment plan.” Left Main & Multi-Vessel: Updated Practice and New Concept Friday, April 25, 8:30 AM-9:40 AM Coronary Theater, Level 1 Check The Session

May 30, 2025 1135

1 2 3 4 5 ❯ ❯❯